NPIMap

Organization Active NPI

Joseph R Agostinelli DPM PA

  • Foot & Ankle Surgery Podiatrist
  • Fort Walton Beach, FL
National Provider Identifier
1528100088
Registry record updated May 30, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
PO0002643 Issued in FL
Legal business name
JOSEPH R AGOSTINELLI DPM PA
Practice address
1034 Mar Walt Dr Ste 100
Fort Walton Beach, FL 32547-6645
Phone
(850) 863-2153
Fax
(850) 315-9350
NPI assigned
Feb 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 30, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Joseph R Agostinelli, DPMNPI 1932103397
Title
Physician
Phone
(850) 863-2153

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213ES0103X PO0002643 FL Primary

Addresses

Primary practice location

1034 Mar Walt Dr Ste 100
Fort Walton Beach, FL 32547-6645

Mailing address

1034 Mar Walt Dr Ste 100
Fort Walton Beach, FL 32547-6645
Phone (850) 863-2153

Other identifiers 2

IdentifierTypeStateIssuer
65837OtherFLBS PROVIDER NUMBER
340506100MedicaidFL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212105600000",
    "number": "1528100088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1034 MAR WALT DR STE 100",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476645",
            "telephone_number": "850-863-2153",
            "fax_number": "850-315-9350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1034 MAR WALT DR STE 100",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476645",
            "telephone_number": "850-863-2153",
            "fax_number": "850-315-9350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOSEPH R AGOSTINELLI DPM PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-13",
        "last_updated": "2008-05-30",
        "status": "A",
        "authorized_official_last_name": "AGOSTINELLI",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "850-863-2153",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "FL",
            "license": "PO0002643",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BS PROVIDER NUMBER",
            "identifier": "65837",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "340506100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Walton Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.